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[2a] A ⼀ Step 2 OD USLME > ✅F2 (GI / RHEUM-ORTHO / HEME-ONC/ENDOCRINE/ SURGERY) > Flashcards

✅F2 (GI / RHEUM-ORTHO / HEME-ONC/ENDOCRINE/ SURGERY) Flashcards

1
Q

Name the differentiating sx between [Mallory Weiss tear] and [Boerhaave Esophageal Perforation]

A

both have NV➜ hematemesis

MW: [partial thickness esophageal tear]

________________

BEP: [FULL thickness esophageal tear] | [Perforation sx (fever/retrosternal cp/ L pleural effusion)]

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2
Q

[Boerhaave Esophageal Perforation] dx

A

[water soluble contrast esophagogram]

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3
Q

[Boerhaave Esophageal Perforation] MOD

________________

Delay of surgical intervention leads to what complication

A

repeat vomiting ➜ [distal 1/3 full thickness esophageal tear] ➜ release of gastric content into sterile mediastinum

= [ACUTE RETROSTERNAL CHEST PAIN (+/- L pleural effusion c/b PTX or Pneumomediastinum)]

________________

Fatal Mediastinitis within 24H

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4
Q

cp for [Perforated gastric ulcer]

A

acute severe abd pain with [free air under diaphragm on upright CXR] + HDUS= SURGICAL EMERGENCY

________________

HDUS: HemoDynamicallyUnStable

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5
Q

Scoliosis is mostly caused by ⬜

What clinical features are c/f pathologic Scoliosis (i.e. spinal tumor)? -4

A

idiopathic
________________

Back Pain / Neuro ∆ / [rapid progressive curve] / [abnormal vertebrae]

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6
Q

Between Marfan and Ehlers Danlos, which is a/w velvety skin & easy bruising?

A

Ehlers Danlos

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7
Q

What similar s/s do Marfan and Ehlers Danlos have in common? -4

A

[MSK (joint hypermobile / Pectus excavatum / Scoliosis)]

[Cardiac: MVP]

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8
Q

Why are pts with Ehlers Danlos Syndrome at ⇪ risk for acute mitral regurgitation?

A

EDS = in addition to [Skin/Msk/GU] sx…

EDS also cuases myxomatous degeneration (and ultimately RUPTURE) of the chordae tendineae

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9
Q

[High Risk SQC (on face/ears/sensitive areas)] is treated using ⬜. Why is this tx used?

________________

low risk SQC = < 2 cm lesions on trunk or extremities (excluding hands/feet)

A

[HRS] = [Mohs micrographic surgery] ; has higher cure rate than standard exicision and is great for cosmetic or functional areas

________________

[LRS] = curettage + electrodesiccation (mechanically + electrically destroys CA)

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10
Q

⬜ infections develop in up to 50% of patients with acute variceal bleeding.

Management -2?

A

BACTERIAL (SBP/PNA/UTI) ;

( [Ceftriaxone IV x 7 days] prophylaxis)

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11
Q

Why do patients with [(SSS) Scleroderma Systemic Sclerosis] receive routine Pulmonary Function Test when diagnosed ?

A

Both SSS types {Diffuse (ILD)} and {CREST Limited (pulmonary HTN)} ➜ [⇪ Lung pathology] = PFT (to guide/track disease)

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12
Q

In [Scleroderma Systemic Sclerosis], list the 2 long term complications for SSS type:

[Diffuse Cutaneous (Anti Scl-70)]
________________

[CREST Limited Cutaneous (AntiCentromere)]

A

[Diffuse Cutaneous (Anti Scl-70)] = Interstitial Lung Dz + Renal Crisis ________________

[CREST Limited Cutaneous (AntiCentromere)] = pulmonary htn + Renal Crisis

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13
Q

the primary tx for all Hernia is what?

A

surgery
_________________
complications: incarceration vs strangulation

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14
Q

characteristic features of [Toxic Adenoma Thyroid Nodule]

A

SYMPTOMATIC HyperThyroid

+

[Radioiodine uptake in nodule] with suppressed uptake in remainder of gland]

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15
Q

tx for [Toxic Adenoma Thyroid Nodule] -2

A

[PreTx (Methimazole)]

➜

[DefinitiveTX (RADIOACTIVE IODINE ABLATION OR SURGERY)]

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16
Q

Polycythemia is ⬜ in Men and ⬜ in Women. measuring EPO is first step in working up Polycythemia
_________________
⬜ is the most common cause of 2° polycythemia.

A

hgb: M >18.5 | W>16.5
_________________

CHRONIC HYPOXIA

(consider carboxyhgb and sleep apnea)
_________________
polycythemia? ➜ [**low EPO = polycythemia vera] vs [HIGH EPO = 2° polycythemia (chronic hypoxia or Renal Cell Carcinoma)]

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17
Q

Polycythemia is ⬜ in Men and ⬜ in Women. What’s the first step to evaluating polycythemia?
_________________
How do you interpret this data? -2

A

hgb: M >18.5 | W>16.5

measure Erythropoietin
_________________
polycythemia? ➜ [**low EPO = polycythemia vera] vs [HIGH EPO = 2° polycythemia (chronic hypoxia or Renal Cell Carcinoma)]

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18
Q

s/s of Compartment Syndrome -6

A

[Pain (especially with Passive stretch)]

Paresthesia

Poikliothermia
_________________

Paralysis

Pulselessness

Pallor

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19
Q

Name and Describe the test used to diagnose [Achilles tendon complete rupture]

A

Thompson test

while patient is prone, MD squeeze’s patient’s calf ➜

[NO plantar flexion = RUPTURE] vs [+plantar flexion = Achilles intact]

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20
Q

Tx for Fibromyalgia -4

A

1st: Aerobic Exercise
2nd: TCAs / SNRIs / Anticonvulsants

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21
Q

FibroMyalgia is a clinical diagnosis

What labs are ordered to rule out other similar conditions? -3

A

TSH / CBC / ESR

________________

FibroMyalgia

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22
Q

What are the 4 most common causes of Myopathy (⬆︎ CPK)

A

Statins Probably hurt Muscles

  1. Statins
  2. Polymyositis vs. Dermatomyositis (autoimmune)
  3. Muscular Dystrophy
  4. hypOthyroidism (OR HYPERthyroidism)
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23
Q

What’s the single most important risk factor for Osteoporosis?

A

AGE
_________________
less RF: fam hx / smoking / EtOH

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24
Q

What are the 2 features of [Subclinical hypOthyroidism]?

________________

[Subclinical hypOthyroidism] is usually not treated. What are the 4 exceptions?

A

[⇪ TSH] with [normal T4 Thyroxine]

________________

  1. antiThyroid antibodies (antiTPO)
  2. abnormal lipid profile
  3. hypOthyroidism sx
  4. ovulatory/menstrual dysfunction
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25
Q

Angiodysplasia is an uncommon cause of ⬜

What are the 3 major risk factors?

A

[painless GI hemorrhage]
_________________
Aortic Stenosis / Von Willebrand disease / Chronic Kidney Disease

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26
Q

define

Specificity

A

sPecificity = [true negative]

= “a test’s probability (in the ABSENCE of disease) a patient test negative”

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27
Q

Chronic Granulomatous Disease is a (⬜Mode of Inheritance) that usually p/w ⬜ shortly after birth from ⬜
_________________

MOD for Chronic Granulomatous Disease

A

[X-linked recessive 1° immunodeficiency] ; recurrent infections ;

[catalase positive organisms (Aspergillus = MAJOR COD / Staph A=liver/skin abscess/adenitis)
_________________
[Loss of NADPH oxidase] impairs intracell killing of [phagocytosed bacteria and fungi] ➜ recurrent infections

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28
Q

Central Retinal Artery Occlusion

management? -2

A

[⬇︎Intraocular pressure] + Optho consult
_________________

acute painLESS monocular vision loss

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29
Q

Central Retinal Artery Occlusion

clinical presentation
_________________

Fundoscopy findings? -2

A

acute painLESS monocular vision loss
_________________
[Retinal pallor 2/2 diffuse ischemia] + [Cherry Red Macula]

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30
Q

Macular degeneration affects [⬜ central | peripheral] vision, while Glaucoma affects [⬜ central | peripheral] vision

A

MaCular –> CENTRAL vision loss

with straight lines appearing curvy (wet/exudative-neovascular= aggressive and uL while dry/atrophic=gradual and BL)

________________

Glaucoma –> peripheral vision loss (gradual tunnel vision)

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31
Q

clinical presentation for

Retinal Detachment - 3

A
  1. Floaters
  2. [Descending Visual Curtain PERIPHERAL➜ central]
  3. Photopsia Flashes of Light
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32
Q

clinical definition of Rectal Prolapse
_________________

When is surgery indicated? -2

A

when mucosal or full-thickness layer of rectal tissue slides thru anus
_________________
[complete rectal prolapse] or

[prolapse with fectal incontienence and/or constipation]

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33
Q

what’s management of

partial SBO (*air in distal colon on XR*)? -2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

COMPLETE SBO?

A

partial SBO = [conservative x 24h] –(sx persist)–> [XLAP]
_________________

COMPLETE SBO = XLAP

_________________
conservative = IVF / NG suction / electrolyte correction

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34
Q

⬜ should always be considered in patients with multiple complicated fractures.

What is the symptom triad for this condition?
_________________

How is this prevented?

A

Fat Embolism ;

PBS

Petechial rash

Brain impairment

[SOB (respiratory insufficiency)]

_________________
Early immobilization and operative fixation of fracture

_________________

HEPARIN/ENOXAPARIN DOES NOT AFFECT FAT EMBOLISMS

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35
Q

Typically, [CRC Colonoscopy screening] starts at age ⬜ –and if normal–> repeats every ⬜ years
_________________

How does this differ for patients who have Ulcerative Colitis -2

A

45 ; 10
_________________

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36
Q

Typically, [CRC Colonoscopy screening] starts at age ⬜ —and if normal–> repeats every ⬜ years
_________________

How do you manage a patient who instead underwent flexible sigmoidoscopy and was positive for adenomatous polyps?

A

45 ; 10
_________________

COLONOSCOPY STAT

(follow +sigmoidoscopy with STAT Colonoscopy to scan entire colon for proximal colon adenomas and advanced neoplasia)

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37
Q

Typically, [CRC Colonoscopy screening] starts at age ⬜ –and if normal–> repeats every ⬜ years
_________________
How does this differ for patients who have either [high risk adenomatous polyps] or [First Degree Relatives with CRC] ?

A

45 ; 10
_________________
HR: 40 ; 5

IF HIGH RISK: [Cscope at 40 yo (or 10y prior to age FDR received dx) (which ever is first)]

then [Repeat every 5 years (or 10 if FDR diagnosed > 60 yo)]

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38
Q

Dumping Syndrome MOD

________________

Dumping Syndrome Sx(5)

A

rapid emptying of hypertonic stomach contents into Duodenum & small intestine (usually after gastrectomy or RYGB) –> DDUMP

________________

Diarrhea

Diaphoresis

[Umbilical ABD Pain]

M (N)ausea

Palpitations

worst after eating and better at night

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39
Q

[SIBO - Small Intestinal Bacterial Overgrowth] MOD
_________________

clinical features of SIBO (6)

A

surgery ➜ blind loop of small intestine that (especially if partially obstructed by intraabd adhesion) allows bacterial overgrowth ➜ SIBO sx
_________________

Stinky flatulence / [Intestinal lack of TTP OR Fever] / [Bloating | B12 deficiency | +Breath LactuLOSE test] / [Oasis WATERY Diarrhea]

_________________

[NO abd pain (CDiff has diffuse abd pain)]

[NO fever (CDiff has FEVER)]

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40
Q

Clostridioides difficile MOD

A

Ingested spores (transmitted by fecal-oral route) germinate in COLON = become fully functional bacilli ➜ proliferate unchecked when COLON FLORA IS DISRUPTED ➜ [⇪ release of exoToxin A and B] ➜ mucosal inflammation ➜

[PROFUSE WATERY DIARRHEA ≥ 3 LOOSE STOOLS daily]

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41
Q

[West Nile Arbovirus] can cause ⬜ following a bite from an infected ⬜
_________________

What time of year does this typically present?

A

MeningoEncephalitis ; mosquito
_________________
Summer

_________________
Fever / AMS / HA / Nuchal rigidity / Vomiting

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42
Q

clinical presentation for [Open Globe Laceration] -2
___________________

what causes this injury?

_________________

management? -4

A

teardrop pupil and [DEC visual acuity]
_________________

[small sharp objects penetrating globe at high velocity]

_________________

[IV abx / eye shielding / eye CT / Optho consult]

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43
Q

Elevated ⬜ in pts with [Medullary Thyroid CA s/p total thyroidectomy] indicate ⬜ ?
_________________

How do you work this up? -3

A

calcitonin; METASTASIS

_________________
[metastatic medullary thyroid CA dx] ➜ [CT neck/chest (look for metastasis)] ➜ Surgical Resection

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44
Q

What type of goiters develop from iodine deficiency?
_________________
How do you treat [retrosternal goiter w/compressive sx]?

A

multiNodular
_________________
Surgery

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45
Q

Diagnostic criteria for Nightmare Disorder - 3

A
  1. Recurrently wakes from sleep reMember the nightmare
  2. Child is fully alert on awakening
  3. Child can be consoled

NightMares occur during REM and is developmentally normal for kids

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46
Q

What is the difference between Sleep Terrors and Nightmare Disorder? - 4

A

Sleep terrors are :

  1. NON-REM disorder
  2. with incomplete awakenings
  3. and can NOT be consoled
  4. and pt Seems to forget the dream
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47
Q

For cp, what are 2 ways to differentiate Sleep Terrors from [RSRBD]?
________________
RSRBD = REM Sleep Related Behavioral Disorder

A

[Sleep Terror = NONrem] | [RSRBD= REM]
________________
[ST = abrupt hyperarousal from sleep] | [RSRBD=”acting out dreams”]

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48
Q

What is the clinical progression for [NONrem sleep disorders] like Sleep Walking and Sleep Terrors?

A

onset 4-12 yo ➜ RESOLVES SPONTANEOUSLY ≤ 2 YEARS FROM ONSET –(if SEVERE = low-dose benzo qhs)

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49
Q

Describe the clinical tool used to assess whether a pt is seriously contemplating suicide

A

SAD PERSONS

Each is worth 1 point and [normal 4–(outpt tx)–7 –> Hospitalize now!]​

Sex Male

Age external to 19-45

Depression diagnosis

Previous attempt hx (STRONG RISK FACTOR!)

EtOH/substance abuse

Rational thinking impaired (psychosis, delusions, hallucinations)

Social support lacking

Organized plan

No significant Other

Sickness physically (i.e. chronic pain)

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50
Q

What is Statistical power?
_________________

How do you mitigate low statistical power?

A

ability to detect an association if that association exist. Based on sample size. Larger sample size helps control all confounders ➜ ⇪ Statistical power
_________________
META ANALYSIS (pools data from several studies to INC statistical power)

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51
Q

Subclinical Hyperthyroidism Thyrotoxicosis is defined as ⬜
_________________

When is treatment indicated for subclinical Hyperthyroidism -3

A

low TSH with normal T4
_________________
treat with rx or Radioctive iodine if

[TSH < 0.1] or [≥65 yo] or [comorbid conditions present (heart disease, osteoporosis)]

52
Q

[Clubfoot Equinovarus] is a deformity of the ⬜ bone which results in what clinical presentation?
_________________

Tx for this?

A

Talus; PIA BL feet [Plantar flexed + Inverted + ADDudcted]
_________________
serial Foot Cast

53
Q

infant presents with refractory candidiasis

suspected diagnosis?

A

infant HIV

54
Q

s/s Zinc Deficiency -4
_________________
must be confirmed by lab

A

Doesn’t grow

Diaper rash

Dermatitis perioral

Diarrhea

55
Q

what are the rules regarding Physicians observing misconduct from another Physician ? -2

A

Physicians are ethically obligated to report colleagues (to State Medical Boards) who are

impaired/incompetent/unethical

or who subject patients to potentially harmeful tx

56
Q

How do you manage a patient presenting after accidentally swallowing a sharp fish bone?

A

EMERGENT FLEX ENDOSCOPY
_________________
any sharp object in esophagus must be removed emergently with flex endoscopy

57
Q

Boundary Violations are defined as ⬜

How are they managed? -3

A

serious transgressions against physician safety and/or well-being (such as unwanted touching)
_________________
1st: reinforce hospital code of conduct with patient

2nd: REASSIGN PHYSICIAN
3rd: document alert in patient’s chart

58
Q

patients with large TBSA burns have high mortality rates

How do you determine if burn patients require hospice?

A

rBS = [age + TBSA (+17 if inhlation injury present)] > 140

[revised Baux score] > 140 = poor survival pgn

_________________

59
Q

How do you differentiate cp of duodenal ulcer vs gastric ulcer
_________________

Whats the tx for HPylori Ulcer -3

A

[DEC = D​uodenal] <–(EPIGASTRIC PAIN AFTER MEAL)–> [GETS WORST = Gastric]
_________________
CAP it!

Claroithromycin / Amoxicillin / [PPI omeprazole]

60
Q

After Triple Therapy, what 3 clinical elements warrants CONFIRMATION of H Pylori eradication?
_________________

How is eradication confirmation done? -2

A

duodenal ulcer | ongoing dyspepsia | MALT lymphoma
_________________

([Urea Breath test] or [Fecal Antigen test])

x 4 weeks after Triple Therapy

61
Q

clinical presentation for Meniscal tear

A

subacute or chronic LOCKING/CATCHING sensation of the Knee

+/- ➜ gradual effusion

62
Q

In patients with SEVERE malnutrition, which route of administration is the preferred method of rehydration? why?
_________________

A

ORAL –(if oral insufficient)–> NG –(if pt in shock)–> [IV 10 cc/kg over 30m]
_________________
IV rehydration in chronic malnourishment may cause fluid overload ➜ HF

63
Q

What is Chronic Exertional Compartment Syndrome?

A

muscular volume expansion during endurance exercise ➜ INC pressure within fascial compartment of BL lower leg➜ chronically impairs tissue perfusion .

alleviated with rest and nml activity

TX = elective fasciotomy

64
Q

What are the 4 possible effects amiodarone can have on the Thyroid?
_________________

How are each treated?

A
65
Q

how are hip fractures in the elderly managed? (2)

A

[ambulatory/stable] = ORTHO SURGERY WITHIN 48H

[non-ambulatory/dementia/medically unstable] = Nonoperative management

66
Q

Organophosphate poisoning MOD
_________________

Tx? (2)

A

AChE inhibitor –> TOO MUCH ACh in cleft –> DUMBELS

  • Organophospahtes are used in Agricultural Pesticides*
  • TX = Atropine + [Pralidoxime (reactivates AChE)]*
67
Q

Biostatically, what are the major benefits of smoking cessation?

A

Smoking Cessation AT ANY AGE ⬇︎ risk of [all-cause mortality and CV events] within 5 years after you stop

68
Q

How should you counsel on smoking cessation? (5)

A

5 A’s (KCVSR)

  • A*sK patient about their tobacco usage every visit
  • A*sCertain readiness to quit
  • A*dVise to quit
  • A*Ssist with Rx or cessation programs
  • A*Rrange quit date + follow up appointments

_________________
smoking cessation ⬇︎ [all cause mortality (including Lung CA, CV events and COPD)] within 5 years after you stop

69
Q

sx of Viral Meningoencephalitis (5)
_________________

Etiologies include (⬜3) and treatment is (⬜2)

A

[MeningoEncephalitis (+AMS and focal neuro ∆ )] vs [Meningitis (No AMS)]

70
Q

What are the sx of Acute Epididymitis (4)?
_________________

What are the causes? (2)

A
  1. Epididymitis = Elevation of testicle alleviates
  2. Edema of Epididymis
  3. uL POST testicle pain
  4. [(if E.Coli BOO) DUS urianry sx]

_________________

[STI (Chlamyd/Gonorrhea)] < [Age 35] < [Bladder outlet obstruction (E.Coli)]

71
Q

What’s the 1ST medication given for Atheroslcerosis?
_________________

When is it actually indicated to give? (3)

A

STATIN
_________________

  • [LDL ≥190]
  • [age ≥40 + DM]
  • [(10y ASCVD risk) ≥7.5%]

________________

THIS IS REGARDLESS OF BASELINE LDL

72
Q
  • [SEVERE HYPERTRIGLYCERIDEMIA] occurs when serum level TAG is ⬜ mg/dL. SEVERE HYPERTRICLYCERIDEMIA is a risk factor for developing ⬜*
  • ________________*

Name tx for SEVERE HYPERTRICLYCERIDEMIA -2

A

>1000 ; [HTAP - HyperTriglyceridemia Associated PANCREATITIS]

________________

[Insulin or Apheresis (to lower serum TAG acutely)] + [FIBRATES (for HTAP tx and px)]

________________

Pts with HTAP hx require long term Fibrates for acute tx and prevention

73
Q

Clinical presentation for Illness Anxiety disorder

A

Anxiety over possibility of having serious Illness even though there are little to no symptoms

for ≥6 months

In Somatic symptom disorder….Somatic symptoms ARE present!

74
Q

define Spondylolisthesis

_________________
clinical presentation

A

ANT slippage of 1 vertebral body over another 2/2 BL defects of the [pars interarticularis (spondylolysis)]
_________________
Teen athlete who performs repetitive back extension and rotation ➜ low back pain exacerbated by lumbar extension

tx = analgesics / activity cessation x 90d

75
Q

describe Autoimmune hepatitis
_________________
lab findings (2)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
 diagnostic labs (2)
A

autoimmune progressive parenchymal liver damage of young women that may ➜ cirrhosis and liver failure in 6 mo
_________________

[⇪ALT and ⇪AST +/- ALP] and [normal bilirubin level]

_________________
[ANA] / [AntiSmooth Ab]

76
Q

[Thiamine B1] deficiency causes ⬜ and BeriBeri

________________

Describe BeriBeri (2)

A

[Wernicke Korsakoff Syndrome] and [BeriBeri]

________________

BeriBeri (Wet vs. Dry vs. BOTH) is associated with…

  1. Heart involvement = WET
  2. Symmetrical Peripheral Neuropathy = DRY

[Thiamine B1] is needed to Decarboxylate a-ketoacids (carb metabolism)

77
Q

Chronic Granulomatous Disease MOD
_________________

management? (2)

A

[X-linked defect in neutrophil (NADPH oxidase)] ➜ impairs neutrophil superoxide formation ➜ impaired neutrophil intracellular killing ➜ recurrent [catalase positive infections]
_________________

[bactrim+ itraconazole] px

_________________

  • (catalase+) infections = staphA/Burkholderia cepacia/Serratia/Nocardia/Aspergillus*
  • dx = nitroblue tetrazolium test*
78
Q

How are the results of the D-xylose test interpreted? ; How does Rifaximin play a role in this?

A

In patients with steatorrhea/fatty stool…

It differentiates between

  1. Celiac disease (D-xylose will be LOW in the urine because it can’t be reasbsorbed in the small intestine because of villous atrophy)
  2. Pancreatic insufficiency (D-xylose will be HIGH because absorption occurs normally and pancreatic enzymes never break down D-xylose)

**Small Intestine Bacterial Overgrowth can digest D-xylose before it has the chance to be reabsorbed –> Falsely low D-xylose. Rifaxmin abx prevents this**

79
Q

What type of diarrhea is associated with decreased stool osmotic gap < 50

A

Secretory

these are larger volume diarrhea that occurs during fasting or sleep

80
Q

What type of diarrhea is associated with INCREASED stool osmotic gap > 125

A

Osmotic

ex: Lactose intolerance

81
Q

What are the laboratory findings for Lactose intolerance? - 5

Lactose intolerance is most commonly seen in Asians

A
  1. ⬆︎stool osmotic gap (osmotic diarrhea)
  2. +reducing substances in stool
  3. +hydrogen breath test (indicates intestinal bacterial carbohydrate catabolism)
  4. acidic stool pH
  5. NO steatorrhea

Lactose Intolerance is most commonly seen in Asians

82
Q

What are the laboratory findings for Lactose intolerance? - 5

Lactose intolerance is most commonly seen in Asians

A
  1. ⬆︎stool osmotic gap (osmotic diarrhea)
  2. +reducing substances in stool
  3. +hydrogen breath test (indicates intestinal bacterial carbohydrate catabolism)
  4. acidic stool pH
  5. NO steatorrhea

Lactose Intolerance is most commonly seen in Asians

83
Q

What type of diarrhea is associated with INCREASED stool osmotic gap > 125

A

Osmotic

ex: Lactose intolerance

84
Q

What type of diarrhea is associated with decreased stool osmotic gap < 50

A

Secretory

these are larger volume diarrhea that occurs during fasting or sleep

85
Q

There are 4 Malabsorption syndromes

Describe clinical features of Chronic Pancreatitis (2)

A
86
Q

There are 4 Malabsorption syndromes

Describe clinical features of Lactose Intolerance (4)

A
87
Q

Classic triad for [Spindal Epidural Abscess]

A

1-focal back pain

2-neuro deficits

3-fever

dx = contrast MRI

88
Q

Spinal Epidural Abscess p/w ⬜ ⬜ and ⬜
_________________

How do you manage SEA? (4)

A

focal back pain / neuro deficits / fever
_________________

  1. [contrast MRI spine]
  2. [Infxn labs (ESR/CRP/CBC/bcx/spinal aspirate cx)]
  3. [IV Vanc + Ceftriaxone]
  4. [Emergency Surgical Decompression/I&D within 24 HOURS]
89
Q

What are the 5 steps to appropriately transport an amputated extremity?

________________

How long will this sustain viability?

A

“SPLIT extremity!? wrap in… “

Saline moistened gauze. THEN put in-

Plastic bag.

Lid seal bag shut before putting it on

Ice/Saline 50/50 mix bed. to keep

Temperature ideal (33.8 - 50 F) as to NOT FREEZE extremity

________________

24 hours

90
Q

tx for Viral gastroenteritis (3)

A

self-limited

  1. oral rehydration (mild)
  2. IV REHYDRATION (SEVERE)
  3. Low Fat/Low Sugar regular diet as tolerated
91
Q

what are the s/s of Viral gastroenteritis (3)
_________________

it is transmitted via ⬜ with which 2 viruses?

A

[WATERY DIARRHEA +/- vomiting]

Abd pain

[+/- Fever]
_________________

92
Q

Explain what the HIV test window period is and why it’s important

A

during first 4 weeks of infection, low titers of antigen and antibody may ➜ FALSE NEGATIVE. So if suspicious for HIV infection, retest ≥4 weeks after initial exposure
_________________
HIV test = p24 antigen + HIV1 ab + HIV2 Ab

93
Q

Prior to initiating HAART for HIV infection, coinfection with ⬜ is determined first. Why is this?

A

Hepatitis B
_________________
Some antiretrovirals have DUAL activity against HIV and HBV

94
Q

The major side effects of [INH Isoniazid] for TB are peripheral neuropathy and ⬜.

How do you manage each side effect?

A

[HEPATITIS]

(measure LFTs now then q 3 mo ➜ dc INH if LFT [≥5x baseline] or [≥3x baseline with sx] )
_________________

supplement INH with [PYRIDOXINE B6] (INH outcompetes ([pyridoxine B6] - a cofactor in synthesizing synaptic NTS) so giving more [pyridoxine B6]) ➜ prevents

[peripheral neuropathy]

95
Q

Describe the process of EtOH breakdown to Acetic Acid and explain how Metronidazole disrupts this

A

Metronidazole has Disulfiram-like activity –> Acetaaldehyde accumulation –> Flushing/NV/Cramps after drinking

96
Q

MOD for APAP overdose
_________________

How does EtOH affect this process? (2)

DELAYED HOSPITAL PRESENTATION = WORST OUTCOME

A

during APAP OD,

APAP –(via CYP2E1)–> [toxic NAPQI] and [toxic NAPQI] depletes intrahepatic glutathione as it’s ➜ [NON-TOXIC cysteine & mercapturic acid]

once intrahepatic glutathione is all depleted [toxic NAPQI] accumulates ➜ hepatotoxicity

_________________

acute EtOH competes for 2E1 ➜ DEC [toxic NAPQI] = protective

CHRONIC EtOH upregulates 2E1 ➜ IC [toxic NAPQI] = exacerbant
_________________

[Activated Charcoal (if within 4h post ingestion)]- binds APAP

[NAC (most effective within 8 hrs post ingestion)] ⇪ intrahepatic glutathione and restores [(toxic NAPQI) ➜ (nontoxic cysteine & mercapturic acid)]

97
Q

MOD for APAP overdose
_________________

⬜ and [N-acetylcysteine] are mainstay treatments, but NAC is most effective if given ⬜. How does NAC work?
_________________

DELAYED HOSPITAL PRESENTATION = WORST OUTCOME

A

during APAP OD,

APAP –(via CYP2E1)–> [toxic NAPQI] and [toxic NAPQI] depletes intrahepatic glutathione as it’s ➜ [NON-TOXIC cysteine & mercapturic acid]

once intrahepatic glutathione is all depleted [toxic NAPQI] accumulates ➜ hepatotoxicity

_________________

[Activated Charcoal (if within 4h post ingestion)]- binds APAP

[NAC (most effective within 8 hrs post ingestion)] ⇪ intrahepatic glutathione and restores [(toxic NAPQI) ➜ (nontoxic cysteine & mercapturic acid)]

_________________
protective < [EtOH chronicity] < exacerbant

98
Q

How do you diagnose APAP OD? (2)
_________________

⬜ and [N-AcetylCysteine] are the 2 mainstays of treatment. When is NAC most effective?

DELAYED HOSPITAL PRESENTATION = WORST OUTCOME

A

[Activated Charcoal (if within 4 h post ingestion)]

NAC is most effective when given within 8 hours post ingestion prior to hepatoxicity

99
Q

Describe pathophysiology for acute APAP OD
_________________

Describe the 4 clinical stages of APAP OD

A
100
Q

[EBV infectious mononucleosis] ⇪ risk of splenic rupture, intraabd hemorrhage and hypOvolemic shock

What is the 1st step in managing splenic rupture 2/2 EBV?

A

VOLUME RESUSCITATION
_________________
[once stable (SBP>90) obtain CT abd to assess severity] or [XLAP if pt remains HDUS despite volume resuscitation]

101
Q

Slipped Capital Femoral Epiphysis is a complication of childhood obesity

MOD
_________________

management?

A

fat teen ➜ [ANT SUP slippage of femoral neck] ➜ [POST INFERIOR displacement of Femoral head] ➜ [Months of vague hip/knee pain]
_________________

[surgical pinning within 24 HOURS]

102
Q

Slipped Capital Femoral Epiphysis is a complication of childhood obesity

When does this present?

________________

How does this present?

________________

dx?

A

puberty (most common hip disorder in fat teens!)

________________

[M: Months of vague hip/knee pain] without acute onsets

________________

pelvis XRay

fat teen ➜ [ANT SUP slippage of femoral neck] ➜ [POST INFERIOR displacement of Femoral head] ➜ [Months of vague hip/knee pain]

103
Q

How does Alcoholic ketoacidosis clinically present? (4)

how is this different from DKA?

_________________

tx for Alcoholic ketoacidosis?

A

suspected Alcoholic with:

AG acidosis

INC osmolar gap

ketones

variable blood glucose (DKA has BG > 250)
_________________
tx = [Dextrose IVF with thiamine]

dextrose will ➜ insulin secretion ➜ metabolism of ketone bodies to HCO3

104
Q

In Spinal Stenosis, pts pain is usually exacerbated with _____(flexion/extension) and _____. It is accompanied with ___ symptoms

A

spinal stEEEnosis

EXTENSION ; Exertion (vascular claudication) ; neurological

105
Q

You see an elderly patient leaning over to relieve their pain

⬜ is suspected. How is it confirmed?

management? (2)

A

[Spinal StEnosis secondary to Osteoarthritis joint degeneration] ; MRI spine

_________________

tx =[lumbar epidrual block] –(if persist)–> [Laminectomy surgical decompression]

Shopping cart sign (lEaning over for relief) = Spinal stEnosis = exacerbated with Extension and Exertion

106
Q

In Lumbar disc herniation, pts pain is usually exacerbated with _____(flexion/extension) and accompanied with ___ symptoms

A

flexion ; UNILATERAL radiculopathy and neurological sx

107
Q

iron deficiency anemia and thalassemia both cause microcytic anemia

What’s a labatory method for differentiating them?

A

Mentzer Index = MCV/RBC

thalassemia < [Mentzer Index of 13] < IRON DEFICIENCY ANEMIA
_________________

108
Q

What is the Tuning Fork test ?

A

easy, inexpensive screen that assess for loss of 2TVP (usually of the BL feet) in DM

2TVP = 2-point/Touch/Vibration/Proprioreception

109
Q

How do you treat diabetic neuropathy? (4)

A

[AGGRESSIVE GLYCEMIC CONTROL]

+

[Neuronal transmission adjusters (Duloxetine|Gabapentin-Pregablin|TCA)]

110
Q

Porcelain Gallbladder is often asymptomatic and found incidentally. What is it?
_________________

Why is it clinically significant?

_________________
What’s the management?

A

gallbladder wall calcification (punctate vs curvilinear) 2/2 chronic cholelithiasis
_________________
INC risk for GALLBLADDER CANCER if punctate calcification ;

[Prophylacic Cholecystectomy (if +sx or +punctate calcification)

111
Q

[AOOD (avascular osteonecrosis osteochondritis dissecans)] etx
_________________
dx

A

osteonecrosis (from [CTS > 20mg/day]/HIV/renal disease) of the [small foot/hand bones], proximal tibia, femoral head, vertebrae, humeral head ➜ bone collapse ➜ joint replacement
_________________

MRI

stage 4 AOOD ➜ Total Hip Replacement

112
Q

Pt jumps from a ladder, landed and now has acute R knee pain

what injury is he likely to have? why?

________________

Describe the XR
_________________

management?

A

R patellar tendon rupture ; sudden forceful unopposed quadricep contraction (landing after jumping) ➜ patella tendon rupture = ANT knee pain/effusion , [inability to extend knee] or [maintain a straight leg with flexed hip]

________________

high-riding patella

  • requires surgery in < 10d*
  • patellar stress fx conversely is gradual osnet, not sudden*
113
Q

What is Osgood Schlatter Disease

A

Traction apophysitis of the tibial tubercle from Self-limited irritation of the growth plate at the tibial tuberosity (front of tibia) possibly –> hard nodule, relieved with rest/growth spurt

xray: lifting of tubercle from the shaft

114
Q

Osgood Schlatter Disease tx -3

A
  1. NSAIDs
  2. Ice
  3. self-limited (stops with end of growth spurt)

xray: lifting of the tibial tubercle from the shaft

115
Q

Name the 5 major Treatments for Rhematoid Arthritis

A

Most Losers Hide Secrets Terribly

MTX

Leflunomide

Hydroxychloroquine

Sulfasalazine

[TNF inhibitors]

116
Q

When are [TNF inhibitors] used in RA therapy?

What’s the major caution with these drugs, and how is this managed? (2)

A

RA patients who fail first-line therapy
_________________
[a/w opportunistic infections (i.e. reactivates latent TB)]

so… screen with [TB PPD] or [interferon gamma release assay] prior to [TNF inhibitors]

117
Q

child presents with 2º enuresis

DDx? -2

_________________

2º enuresis = bed wetting ≥5 yo after established period of nighttime dryess

A

DM (order CBC/CMP)

vs

psychological stressor (I.e. parents’ divorce)

118
Q

cp for McCune Albright syndrome-3

A

all [McCune Albright] does is P P P

  1. Precocious puberty
  2. Pigmented cafe au lait spots
  3. Polyostotic fibrous dysplasia –> bone defects
119
Q

What is [Idiopathic premature pubarche]?

A

[precocious (male <9 / female<8)] and isolated development of pubic hair

with NO other endocrine ∆ ​

120
Q

Pylephlebitis is described as ⬜, and a rare yet devastating complication of ⬜

A

[infective suppurative portal vein thrombosis] ; intraabdominal infections

121
Q

cp for Niacin B3 deficiency - 4

A

DDDD Pellagra

Diarrhea

Dermatitis symmetrical hyperpigmented rash on sun areas

Dementia

DEATH

122
Q

Why does Carcinoid Syndrome cause Niacin B3 deficiency?

A

Carcinoid tumors utilize Tryptophan to secrete tons of Serotonin. Tryptophan is also needed to make Niacin B3. This can –> Pellagra DDDD

Do not confuse Carcinoid Syndrome with VIPoma which presents similarly but VIPoma affects Pancreas while Carcinoid affects small intestine

123
Q

What role does the adrenal gland play in sepsis physiology?

________________

Explain [stress dose steroids]

A

normally, stress (sepsis, surgery) ➜ adrenal gland ⇪ endogenous cortisol ➜ [⇪ adrenergic receptor sensitivity to catacholamines] ➜ [⇪ peripheral vasconstriction and ⇪ cardiac contractility] = MAINTAINS BLOOD PRESSURE DURING STRESS

________________

pts chronically immunosuppressed (RA on prednisone) have hypofunction of adrenal glands (from iatrogenic Cushing syndrome) = [relative cortisol deficiency during infection]➜ require exogenous corticosteroid stress dose steroids =

[Hydrocortisone IV 200 mg/day] to prevent/treat septic shock

124
Q

What is [Inferior petrosal sinus sampling] used for?

A

In patients with elevated ACTH, differentiates source of ACTH ( [Corticotrope Functional Pitutiary Adenoma] vs [Ectopic (SOLC)] )

125
Q

cp Thyroglossal duct cyst
_________________

How should it be managed (2)? why?

A

[s/p URI, superior to thyroid, fluctuant midline neck mass, in kids that moves superiorly when swallowing]
_________________

[Thyroid imaging (to ensure native thyroid is functional) ➜ TDC surgical removal]

(TDC may be the only site of functioning [ectopic] thyroid tissue so obtain thyroid imaging prior to definitive surgical removal)

[2a] A ⼀ Step 2 OD USLME (21 decks)

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